Good correlation between the Afinion AS100 analyser and the ABX Pentra 400 analyser for the measurement of glycosylated haemoglobin and lipid levels in older adults in Durban, South Africa

Background. The Afinion AS100 analyser is a small bench-top, multi-assay, point-of-care (POC) analyser that is able to measure glycated haemoglobin (HbA1c) and lipid levels.Objective. To assess performance of the Afinion analyser compared with a reference laboratory test for the measurement of HbA1c and lipid levels.Method. The study involved men and women enrolled in a cross-sectional study, Sexual health, HIV infection and comorbidity with non-communicable diseases among Older Persons (SHIOP), which was conducted from February to May 2016. Whole blood was drawn aseptically by a trained study nurse into a serum separator gel tube and an ethylenediaminetetra-acetic acid (EDTA) tube. The EDTA whole blood was used to measure HbA1c levels, and serum to measure total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglyceride levels. Lin's correlation coefficient was used to assess the agreement between the Afinion and ABX Pentra 400 analysers for each marker.Results. A total of 435 older individuals were included in the study. The proportion of HbA1c results that were correctly classified by the Afinion analyser was 92.2%. Bland-Altman analysis and linear regression analysis showed a very good agreement (correlation concordance 0.89) between the two analysers for the measurement of HbA1c. The two-way scatter plot for TC showed a substantial correlation (0.80). However, a total of 69 cholesterol results that were within the normal range on the Pentra were misclassified as abnormal on the Afinion. The readings obtained for HDL-C levels with the Afinion were shown to be slightly overestimated when compared with the Pentra. However, correlation for HDL-C on the two analysers was 0.93, indicating an almost perfect agreement. Seventy-four LDL-C results were erroneously classified as abnormal on the Afinion but were within the normal range on the Pentra, resulting in a substantial correlation of 0.75. An excellent agreement was observed between triglyceride measurements (0.99).Conclusion.This study supports the use of the Afinion AS100 analyser in POC testing for the measurement of HbA1c, triglycerides and HDL-C in a South African setting

Experiences of Registered Nurses with Regard to Accessing Health Information at the Point-of-Care via Mobile Computing Devices

Background: The volume of health information necessary to provide competent health care today has become overwhelming. Mobile computing devices are fast becoming an essential clinical tool for accessing health information at the point-of-care of patients.Objectives: This study explored and described how registered nurses experienced accessing information at the point-of-care via mobile computing devices (MCDs).Method: A qualitative; exploratory; descriptive and contextual design was used. Ten in-depth interviews were conducted with purposively sampled registered nurses employed by a state hospital in the Nelson Mandela Bay Municipality (NMBM). Interviews were recorded; transcribed verbatim and analysed using Tesch's data analysis technique. Ethical principles were adhered to throughout the study. Guba's model of trustworthiness was used to confirm integrity of the study. Results: Four themes emerged which revealed that the registered nurses benefited from the training they received by enabling them to develop; and improve; their computer literacy levels. Emphasis was placed on the benefits that the accessed information had for educational purposes for patients and the public; for colleagues and students. Furthermore the ability to access information at the point-of-care was considered by registered nurses as valuable to improve patient care because of the wide range of accurate and readily accessible information available via the mobile computing device. Conclusion: The registered nurses in this study felt that being able to access information at the point-of-care increased their confidence and facilitated the provision of quality care because it assisted them in being accurate and sure of what they were doing

Point-of-Care Estimation of Haemoglobin Concentration in all Age Groups in Clinical Practice

Background: The measurement of haemoglobin (Hb) concentration provides a reliable; primary screening test for the presence and severity of anaemia. The HemoCuer is a point-of-care test for Hb measurement. The introduction of pointof- care testing in hospitals and general practice has improved patient care and accessibility. This study was performed to evaluate the utility of point-of-care Hb measurement with the HemoCuer device for the diagnosis of anaemia. Method: In this prospective study; we compared the analytical performance of the HemoCuer to the Coulterr LH 750 automated haematology analyser with regard to accuracy; precision and linearity in the measurement of Hb in adult and paediatric patient samples; referred for routine laboratory testing. Results: Samples from 100 patients were analysed with both instruments; and the results were compared using standard scatter and difference plots. The mean Hb value of the HemoCuer (11.3 g/dl; range 4.6-16.7) was comparable to the Coulterr LH 750 (11.3 g/dl; range 4.7-17.2). The Bland-Altman difference plot revealed good correlation. Bias between the two methods was small; and the imprecision was within acceptable limits. Hb measurement was linear in the range of 4.8-20 g/dl. Conclusion: In all age groups; the HemoCuer point-of-care device can be used to provide accurate and reliable Hb measurements with a smaller sample volume; improved turnaround time; and long-term cost saving

Evaluation of Point-of-Care Tests for Detecting Microalbuminuria in Diabetic Patients

Background: Microalbuminuria; the presence of low levels of albumin in the urine; indicates renal damage and is recognised as a risk factor for the progression of renal and cardiovascular disease. Several international scientific bodies recommend microalbuminuria screening. Point-of-care testing (POCT) of microalbuminuria allows immediate identification of risk; and monitoring of treatment effects. In this study; two POCT instruments were evaluated as microalbuminuria screening methods. Method: Spot urine specimens from diabetic patients were analysed with the quantitative HemoCuer urine albumin analyser (n = 245); and the semiquantitative Clinitekr microalbumin urine dipstick (n = 204). These results were compared to the respective data for laboratory-determined albumin (nephelometry); creatinine (modified Jaffe) and albumin-to-creatinine ratio (ACR). Results: Linear regression analysis demonstrated a good correlation for the HemoCuer urine albumin with the laboratorydetermined albumin concentration (y = 0.8557x + 0.2487y; r = 0.97). The sensitivities for the HemoCuer and Clinitekr POCTsystems were 79.6and 83.8; and the pecificities 97.1and 93.8respectively. Positive and negative predictive values for the HemoCuer were 95.6and 85.8; and were 88.6and 91.0the Clinitekr. The repeatability of both instruments was excellent. Both instruments are easy to use; and more cost-effective than the laboratory methods for albumin and ACR. Conclusion: Both the HemoCuer and the Clinitekr microalbumin POCT systems for albuminuria are easy to use and inexpensive; and are adequately accurate as a screening method. Although the HemoCuer POCT system measures only urine albumin concentration; its sensitivity and specificity compared well with that of the Clinitekr POCT system; which determines the ACR

Telepsychiatry in South Africa ­ present and future

The recent progress in telepsychiatry results from advancing technology and videoconferencing as an effective alternative to classic face-to-face psychiatric interaction, in terms of both results and cost-effectiveness. The wide range of applications of telepsychiatry is outlined - in particular, emergency, forensic, prison and adolescent psychiatry. Attitudes of patients and the providers of psychiatric services are discussed, and a short account is given of the place of tele-education in psychiatric teaching. The advantages of telepsychiatry are outlined and its limitations. Lastly, the limited experience and relevance of telepsychiatry in South Africa (and hence for other developing countries) are presented. The conclusion is that telepsychiatry is well established, its successes documented, and that it should be applied in planning future public health services in South Africa